Individual
TODD DAVID BLAKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
14406 NE 20TH AVE, VANCOUVER, WA 98686-1448
(360) 571-3053
Mailing address
3905 NW 119TH ST, VANCOUVER, WA 98685-3593
(360) 571-3053
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
WA PA10003448
WA
Other
Enumeration date
08/15/2006
Last updated
07/08/2007
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